Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053606996 |
---|---|
Provider Name | Mr. Ricardo Rodriguez |
First Address | Las Vegas, NV 89119-6137 |
Second Address | Las Vegas, NV 89119-6137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2011 |
Last Update Date | 17/06/2011 |